Healthcare was a key factor in the 2018 midterm elections and gave Democrats the ability to stop the Trump administration’s efforts to repeal the Affordable Care Act and make some other changes to Medicare and Medicaid, but did not produce enough of a victory to advance major changes; voters in 2 states rejected 2 separate union-backed ballot measures that would have affected dialysis clinics and hospitals; in California, Governor-elect Gavin Newsom campaigned on a platform of single-payer health insurance overhaul, but now that he’s won, he and the Democratic-controlled legislature will take a slower approach.

Medicaid Expansions Set to Increase

Healthcare was a key factor in the 2018 midterm elections and gave Democrats the ability to stop the Trump administration’s efforts to repeal the Affordable Care Act and make some other changes to Medicare and Medicaid, but did not produce enough of a victory to advance major changes, Kaiser Health News reported. Republicans retained control of the Senate while Democrats now control the House of Representatives. In addition, Medicaid expansion was passed by voters in Utah, Idaho, and Nebraska; a continuation of expansion appeared likely in Montana. In Kansas, Medicaid might be expanded with the victory of Democratic gubernatorial candidate Laura Kelly; expansion there was previously vetoed by former GOP Governor Sam Brownback. In Maine, Democratic candidate Janet Mills, who won the governorship, has promised to implement Medicaid expansion, which outgoing GOP Governor Paul LePage refused to do.

Voters in 2 states rejected 2 separate union-backed ballot measures that would have affected dialysis clinics and hospitals. California voters rejected Proposition 8 in California, which would have imposed a cap on the profits of dialysis chains like DaVita and Fresenius, The Los Angeles Times reported. The measure would have required clinics to give rebates to insurers and pay a penalty to the state on revenue that exceeded 115% of certain costs to deliver care. DaVita and Fresenius spent $110 million to defeat the measure. In Massachusetts, voters rejected a measure that would have capped the numbers of patients assigned to hospital nurses. The Boston Globe said the ballot question was difficult for many voters to understand and provoked a fierce, expensive campaign.

In California, Governor-elect Gavin Newsom campaigned on a platform of single-payer health insurance overhaul, but now that he’s won, he and the Democratic-controlled legislature will take a slower approach, California Healthline reported. Concerns about the cost—by one estimate, $400 billion annually—and opposition from the Trump administration are forcing him to take a more realistic approach, although that could also upset his relationship with the donors and unions that supported him.